获得性免疫缺陷综合征合并肺隐球菌病患者胸部CT表现的分析

Manifestations of chest CT imaging in AIDS patients complicated with pulmonary cryptococcosis

目的了解获得性免疫缺陷综合征(艾滋病)合并肺隐球菌病患者胸部CT表现的特点。方法回顾性分析2012年1月至2018年7月武汉大学中南医院感染科诊治的72例艾滋病合并肺隐球菌病患者的临床资料,其中3例(4.2%)经组织活检病理检查确诊为肺隐球菌病(1例为单纯肺隐球菌病,2例为播散型隐球菌病),69例(95.8%)为隐球菌脑膜炎(43例)或播散性隐球菌病(26例)伴肺部表现而临床诊断为肺隐球菌病。对患者胸部CT特征进行分析,包括病灶的形态、大小、数目、分布、内部特征及边缘情况。结果72例患者胸部CT主要表现为实性结节或肿块49例(49/72,68.1%),斑片状影40例(40/72,55.6%),空洞性结节10例(10/72,13.9%),纵隔肺门淋巴结肿大17例(17/72,23.6%)及胸腔积液10例(10/72,13.9%)。结论艾滋病合并肺隐球菌病CT表现常见为多发实性结节或肿块、斑片状影及孤立空洞性结节或肿块;对胸部CT出现肺结节或肿块的HIV感染患者应加强隐球菌筛查,以助于早期诊治。

Objective To analysis the manifestations of chest CT imaging in acquired immunodeficiency syndrome (AIDS) patients complicated with pulmonary cryptococcosis. Methods The clinical data of 72 AIDS patients complicated with pulmonary cryptococcosis were analyzed retrospectively. There were 3 cases (4.2%) diagnosed with pulmonary cryptococcosis by biopsy, including 1 case of pulmonary cryptococcosis and 2 cases of disseminated cryptococcosis;69 cases (95.8%) with pulmonary manifestations and clinically diagnosed with pulmonary cryptococcosis, including 43 cases of cryptococcal meningitis and 26 cases of disseminated cryptococcosis. The imaging features of chest CT, in terms of the morphology, size, number, distribution, internal features and margins of the lesions were analyzed. Results The chest CT findings were solid nodules or mass in 49 cases (68.1%), patchy shadows in 40 cases (55.6%), cavitary nodules or mass in 10 cases (13.9%), mediastinal and hilar lymph node enlargement in 17 cases (23.6%) and pleural effusion in 10 cases (13.9%). Conclusion The chest CT findings of AIDS patients complicated with pulmonary cryptococcosis mainly are multiple solid nodules or masses, patchy shadows and solitary cavitary pulmonary nodules or mass. For early diagnosis and treatment, cryptococcus screening should be performed in HIV-infected patients with pulmonary nodules or mass on chest CT.